Effect of Photodynamic Therapy on Halitosis: A Systematic Review of Randomized Controlled Trials.

Pamella De Barros Motta,Sandra Kalil Bussadori,Ana Luiza Cabrera Martimbianco,Kristianne Porta Santos Fernandes,Raquel Agnelli Mesquita-Ferrari,David José Casimiro De Andrade,Lara Jansiski Motta,Elaine Marcílio Santos,Marcela Leticia Leal Gonçalves,Thalita Molinos Campos,Anna Carolina Ratto Tempestini Horliana

doi:10.3390/s22020469

Abstract

Background: This systematic review aimed to assess the effectiveness and safety of aPDT for the treatment of halitosis. Methods: Search strategies were conducted in October 2021 without language or data restrictions, on the following databases: MEDLINE, EMBASE, CENTRAL, LILACS and BBO, as well as a manual search. Randomized clinical trials (RCTs) with parallel design were considered for inclusion, assessing individuals (adolescents and adults) with a clinical diagnosis of halitosis treated with photodynamic therapy (aPDT). Primary outcomes assessed were halitosis measurements, adverse events and quality of life. The risk of bias for each included study was evaluated with the Cochrane Risk of Bias tool and the certainty of the body of the evidence was assessed with the GRADe approach. Results: Six RCTs (total of 225 participants) were included and due to clinical diversities it was not possible to group the outcome data in meta-analyses. Based on very low-certainty evidence (GRADE) the results showed that, when compared to tongue scraper, aPDT seems to promote a little to no difference in reducing halitosis and in the microbiological analysis. No adverse events were reported. Considering aPDT combined with tongue scraper, better outcome results were observed when compared to tongue scraper alone. Conclusions: Based on very low-certainty evidence, the findings of this review are uncertain about the effects of aPDT for halitosis control. Further RCTs with higher number of participants and long term assessments need to be conducted to support the use of this intervention. The protocol was registered in the PROSPERO database (number: CRD42020215319) on 19 November 2020—retrospectively registered.

Highlights

Halitosis is a term that consists of any unpleasant odor emanating from the oral cavity, the source of which may be local or systemic [1]
We considered for inclusion only randomized clinical trials (RCTs) with parallel design
Types of Interventions and Comparators We included Randomized clinical trials (RCTs) that assessed the use of photodynamic therapy at any therapeutic parameter, dose and duration, compared with placebo, no intervention or another active treatment such as tongue scraper

Summary

Introduction

Halitosis is a term that consists of any unpleasant odor emanating from the oral cavity, the source of which may be local or systemic [1] This alteration in mouth odor is the third major cause of the search for oral treatment [2]. The high concentration of mucin in the saliva aids the adhesion of anaerobic microorganisms and epithelial cells in the posterior third of the lingual dorsum [7] This biofilm is called tongue coating [8], and it is the most common cause of halitosis. Based on very low-certainty evidence (GRADE) the results showed that, when compared to tongue scraper, aPDT seems to promote a little to no difference in reducing halitosis and in the microbiological analysis. The protocol was registered in the PROSPERO database (number: CRD42020215319) on 19 November 2020—retrospectively registered

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